Humidity and Sinusitis

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Sharon - 21 Feb 2007 21:09 GMT

    Hey, just found this newsgroup. I've been struggling with a chronic
sinus infection, being treated by an ENT, and am heading for endoscopic surgery
next week. It's kind of embarrassing how interested I am in my nasal output
now... ugh! I have a question and a rant, if you all don't mind.
    First the rant: I'm in northern Virginia. Humid in the summer, dry in
the winter. My office particularly is one of those crappy old buildings with
overactive heating systems that really dry the air out. I get sinus headaches
in the afternoons during the winter. Now that I KNOW I need to get my sinuses
cleared out, it occurred to me to take a little humidistat to work with me just
to assign a measurement to my discomfort. It was around 17-19 percent every
afternoon.
    None of my coworkers complain about the dry air, although they do
complain about the heat or being too cool, so I figured it was just that I'm
especially sensitive to humidity for whatever reason. So I've kept my mouth
shut and just did the best I could. (And yes, I tried a humidifier. Couldn't
keep up with the building furnace...)
    We're moving to a new building in a few weeks, and I really hope it's
going to be better. I asked the move coordinators about the environmentals in
the new building, specifically about the humidity levels. They wrote back that
the building manager said they don't have humidifiers, and in fact they do
everything they can to pull humidity OUT of the air. I thought that was a
pretty ignorant response given that we're in Virginia, not Miami. Oh well.

    Now the question: This has never happened to me before, so I figure it
was caused by a head cold that plugged me up. However, I do now have (or just
got rid of) one polyp in my nose. If you get one, does that make you prone to
getting more, or do they keep coming back? Should I assume that now I am prone
to sinusitis and do the daily rinsing forever as part of my general hygiene?
    Ok, another one: my Reumatologist has been hankering to put me on a
new medication called Enbrel. The stuff is supposed to be really good, but has
a nasty side effect of making any infection you get worse, and is also known to
cause sinusitis. That worries me a bit. When I asked my ENT about it, she
didn't know anything about it. My reumy just wants me to take it asap, so she
doesn't care about the side effects. I understand why it tends to cause sinus
infections, but I haven't been able to get any guidance from my doctors as to
how I should try to prevent sinusitis while taking the Enbrel. Is anyone here
taking it? All I want to know is if I should maintain a super level of hygiene
to fight the possibility of infection, or if there's basically nothing I can do
other than stopping and starting the medication. (I've asked other people who
take Enbrel and a few of them just stop and start it every time they get sinus
problems. Doesn't sound healthy to me...)

- Sharon
"Gravity... is a harsh mistress!"

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Steven L. - 21 Feb 2007 21:55 GMT

> Now the question: This has never happened to me before, so I figure it
> was caused by a head cold that plugged me up. However, I do now have (or just
> got rid of) one polyp in my nose. If you get one, does that make you prone to
> getting more, or do they keep coming back?

Nasal polyps grow in response to inflammation. A steroid nasal spray
can help knock down that inflammation, whatever is causing it. If the
cause of the inflammation can be pinpointed, then that can be dealt with
too. However, the inflammation can simply be caused by the chronic
sinusitis you're already diagnosed with; treat that (via your upcoming
surgery), and maybe you won't get as many polyps in the future.

> Should I assume that now I am prone
> to sinusitis and do the daily rinsing forever as part of my general hygiene?

Wouldn't hurt.

> Ok, another one: my Reumatologist has been hankering to put me on a
> new medication called Enbrel. The stuff is supposed to be really good, but has
> a nasty side effect of making any infection you get worse, and is also known to
> cause sinusitis. That worries me a bit.

I don't think you should take Enbrel with an ongoing sinus infection
(which your chronic sinusitis might be caused by). The manufacturer
says that it can worsen infections and should not be taken if you
already have an active infection.

http://www.rxlist.com/cgi/generic/etanercept_wcp.htm

Let's wait to see how your sinus surgery proceeds. Wait till your
sinuses have healed up properly and you no longer have any chance of
developing a post-operative infection (which is all too common with
sinus surgery).

I developed a Golden Steph post-op infection after my first sinus
surgery, and I sure didn't want to be taking any immunosuppressive meds
at that point.

> When I asked my ENT about it, she
> didn't know anything about it. My reumy just wants me to take it asap, so she
[quoted text clipped - 6 lines]
> take Enbrel and a few of them just stop and start it every time they get sinus
> problems. Doesn't sound healthy to me...)

If your current family physician can't keep track of your ENT and your
rheumatologist's treatment programs, you need to go elsewhere.

You need to find a Primary Care Physician who is board-certified in
Internal Medicine, who can keep track of and help balance the
medications and treatments you're getting from different specialists.
It should *NOT* be your job to reconcile what your ENT is doing for you
with what your rheumatologist is doing for you. That's part of what
Internal Medicine is all about.

I have a number of different health problems, each with its own
specialist treating it, and it's been a real pain in the butt to find an
Internal Medicine physician who can coordinate it all for me. All too
many Primary Care Physicians these days seem to think their job is just
to write referrals to specialists and then wash their hands of your
treatment. If you've got one of those, fire him.

Good luck with your surgery; let us know how it comes out.

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Steven D. Litvintchouk
Email: sdlitvin@earthlinkNOSPAM.net
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Sharon - 22 Feb 2007 15:14 GMT

>> Now the question: This has never happened to me before, so I figure it
>> was caused by a head cold that plugged me up. However, I do now have (or just
[quoted text clipped - 7 lines]
> sinusitis you're already diagnosed with; treat that (via your upcoming
> surgery), and maybe you won't get as many polyps in the future.

Ok. I haven't tried using the steroid nasal sprays, just simple saline
ones. I'll ask my ENT if i should do that post-surgery. I also wonder if the
Saharan humidity in my office is enough of an irritant to cause them. Of
course it's one of those situations where you have to eliminate things one by
one...

>> Ok, another one: my Reumatologist has been hankering to put me on a
>> new medication called Enbrel. The stuff is supposed to be really good, but has
[quoted text clipped - 5 lines]
> says that it can worsen infections and should not be taken if you
> already have an active infection.

Yep, I haven't started my rx for it yet. My first few doses are
sitting snug in my fridge. I find it interesting how deadly serious the Enbrel
people are about advising you DON'T take or start it while you have a sinus
infection. I wonder if their marketing droids talk like that to the doctors
when they visit on Wednesdays. (I'm a tad cynical.)
What I'm also leery about is that Enbrel, since it's injected only once
or twice a week, is one of those drugs that stays in your system a while. So I
suspect that if you discover a sinus infection, skipping your next dose might
be "too little too late". Or rather you might have to skip several weeks'
worth of doses. Just seems like a bit of a rollercoaster to me, but the drug
is new, so they haven't figured it all out yet.

> Let's wait to see how your sinus surgery proceeds. Wait till your
> sinuses have healed up properly and you no longer have any chance of
> developing a post-operative infection (which is all too common with
> sinus surgery).

Ok, that was my plan, although I'm a little fuzzy on how long that
might be. I'll ask my ENT at the followup appt, I think.

> If your current family physician can't keep track of your ENT and your
> rheumatologist's treatment programs, you need to go elsewhere.
[quoted text clipped - 5 lines]
> with what your rheumatologist is doing for you. That's part of what
> Internal Medicine is all about.

I have a pretty good PCP, but I admit to not going to her as much as I
probably should. As cynical as I am about doctors and the medical industry,
one thing I've noticed in the past couple years that I LOVE, is that they're
all now giving me copies of my test results and CDroms with my MRI and CT scans
on them. I've started keeping my own file and giving my docs copies of
everything. I've been keeping them all apprised of my health that way, and by
telling them who's been treating me for what since the last time I saw them.
(In the "old days" I very much didn't appreciate it when they used to
act like my charts were classified materials.)

> Internal Medicine physician who can coordinate it all for me. All too
> many Primary Care Physicians these days seem to think their job is just
> to write referrals to specialists and then wash their hands of your
> treatment. If you've got one of those, fire him.

I suspect that's from pressure from either the patients or the
insurance industry, but of course I don't really know. I know it never
occurred to me to have the PCP coordinate everything. In fact, years ago when
I had insurance that required referrals for everything, I resented that
greatly. I don't anymore, but still do think it's a hassle going to the doctor
too much.

- Sharon
"Gravity... is a harsh mistress!"

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